Provider Demographics
NPI:1023093358
Name:DE MARIA, ALFONSE A (DC)
Entity type:Individual
Prefix:DR
First Name:ALFONSE
Middle Name:A
Last Name:DE MARIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 BIRCHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1905
Mailing Address - Country:US
Mailing Address - Phone:201-236-1864
Mailing Address - Fax:201-891-8404
Practice Address - Street 1:807 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1372
Practice Address - Country:US
Practice Address - Phone:201-891-5599
Practice Address - Fax:201-891-8404
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5301807Medicaid
NJ5301807Medicaid
NJU18163Medicare UPIN